Page 18 - Work Force September 2025

Understanding Empire Plan benefits: preventive, diagnostic and routine care
Preventive, diagnostic, and routine care benefits are common types of health care you may receive under The Empire Plan.
Understanding the difference between them is not always easy, but it is important. Coverage and out-of- pocket expenses can vary, depending on which type of service you receive. Be sure to discuss with your provider why a test or service is being ordered. The same test or service can be considered preventive, diagnostic, or routine (depending
on the description of why it is being performed). As a result, out-of- pocket costs paid by the enrollee may change based on the reason the service is requested.
Preventive care benefits
and services covered by The Empire Plan follow numerous guidelines and standards, including recommendations by the U.S. Preventive Services Task Force (USPSTF), the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, and the Advisory
Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) as well as requirements of the Patient Protection and Affordable Care Act (PPACA). Pediatric guidelines represent consensus by the American Academy of Pediatrics and Bright Future. It is important to check these guidelines often as they are frequently updated.
The goal of preventive care is to detect potentially serious health conditions before symptoms develop and obtain early treatment.
Preventive care can include annual exams, screenings and immunizations. Common examples of adult preventive care include annual wellness visits, cholesterol, high blood pressure and diabetes screenings as well as cancer screenings, such as colonoscopies and mammograms.
Common examples of yearly pediatric preventive care (well- child) can include growth and body mass measurements, developmental screenings, behavioral assessments, and immunizations per ACIP
recommendations. Many preventive services are covered in full when using an Empire Plan participating provider.
Diagnostic care helps diagnose risk factors or treat
symptoms that are
already present.
Diagnostic care would involve following up with your provider
to treat or
monitor
issues. When
a preventive
visit becomes diagnostic, a copayment may
apply when using a participating provider.
Routine care describes care that occurs on a regular basis, but it
is not preventive. Routine care is used to prevent a condition from becoming worse and to help manage symptoms. Common illnesses
that often require routine care include asthma, hypertension and diabetes. Because routine care is not preventive, a copayment may apply when using a participating provider.
Please review the 2025 Empire Plan Preventive
Care Coverage Guide for more details
regarding preventive, diagnostic and
routine care.
As a reminder,
you should review your
Explanation of Benefits Statement
(EOB) regularly. The EOB sent by The
Empire Plan carriers can provide a better
understanding of how the services are billed, what the Plan
pays and your out-of-pocket costs. If you have specific coverage
questions or need assistance finding a participating provider, call the Empire Plan 1-877-7-NYSHIP (1-877- 769-7447).
Live Health Online: Telemedicine option for Empire Plan enrollees and dependents
18 The Work Force
September 2025
It is important to address the ever- changing medical and behavioral health care needs of CSEA members.
As a reminder, CSEA Empire Plan enrollees and dependents have access to convenient virtual visits for $0 out-of-pocket cost using Live Health Online.
These services continue to be cost-effective alternatives for many services that can be treated virtually instead of higher-cost urgent care centers, emergency rooms or in- person office visits.
Since medical and behavioral health can significantly impact day- to-day life, it is important to maintain both physical and mental health.
The Live Health Online telemedicine program offers Empire Plan enrollees and dependents access to covered- in-full telemedicine services from board-certified doctors as well as licensed mental health specialists.
Urgent care virtual visits for medical can be for conditions such as colds/flu, minor rashes, pink
eye or headache. For behavioral health, individuals can speak with
a therapist or psychologist from the privacy of their home or see a psychiatrist and discuss possible medication management needs. Spanish speaking providers are also available.
To get started, visit
anthembluecross.com/nys and select the link to Live Health Online to begin the registration process. When registering, or logging in if already registered, be sure to enter your Empire Plan identification number and name exactly as they appear on your identification card (this will help ensure treatment
is received without charge to the enrollee).
If you need assistance with
the registration process or have questions, call Live Health Online at 1-888-548-3432. Live Health Online has representatives available 24 hours a day, seven days a week to assist you.